                <div class="row">
                        <div class="col-md-3">
                                <!-- INCLUDE sidebar-{CURRENT_PAGE}.tpl -->
                        </div>

                <div class="col-md-9">
                                <h4>{L_25_0010}&nbsp;&gt;&gt;&nbsp;{L_25_0005}</h4>
                                <form name="profile_feilds" action="" method="post">

                                <div class="panel panel-default">
                                <div class="panel-body">
                                        <table width="98%" cellpadding="0" cellspacing="0" class="blank">
                                                <tr valign="top">
                                                        <td width="50%">{L_781}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="birthdate" value="y" <!-- IF REQUIRED_0 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="birthdate" value="n" <!-- IF ! REQUIRED_0 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top" class="bg">
                                                        <td>{L_780}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="birthdate_regshow" value="y" <!-- IF DISPLAYED_0 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="birthdate_regshow" value="n" <!-- IF ! DISPLAYED_0 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top">
                                                        <td>{L_782}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="address" value="y" <!-- IF REQUIRED_1 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="address" value="n" <!-- IF ! REQUIRED_1 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top" class="bg">
                                                        <td>{L_780}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="address_regshow" value="y" <!-- IF DISPLAYED_1 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="address_regshow" value="n" <!-- IF ! DISPLAYED_1 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top">
                                                        <td>{L_783}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="city" value="y" <!-- IF REQUIRED_2 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="city" value="n" <!-- IF ! REQUIRED_2 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top" class="bg">
                                                        <td>{L_780}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="city_regshow" value="y" <!-- IF DISPLAYED_2 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="city_regshow" value="n" <!-- IF ! DISPLAYED_2 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top">
                                                        <td>{L_784}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="prov" value="y" <!-- IF REQUIRED_3 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="prov" value="n" <!-- IF ! REQUIRED_3 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top" class="bg">
                                                        <td>{L_780}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="prov_regshow" value="y" <!-- IF DISPLAYED_3 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="prov_regshow" value="n" <!-- IF ! DISPLAYED_3 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top">
                                                        <td>{L_785}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="country" value="y" <!-- IF REQUIRED_4 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="country" value="n" <!-- IF ! REQUIRED_4 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top" class="bg">
                                                        <td>{L_780}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="country_regshow" value="y" <!-- IF DISPLAYED_4 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="country_regshow" value="n" <!-- IF ! DISPLAYED_4 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top">
                                                        <td>{L_786}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="zip" value="y" <!-- IF REQUIRED_5 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="zip" value="n" <!-- IF ! REQUIRED_5 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top" class="bg">
                                                        <td>{L_780}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="zip_regshow" value="y" <!-- IF DISPLAYED_5 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="zip_regshow" value="n" <!-- IF ! DISPLAYED_5 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top">
                                                        <td>{L_787}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="tel" value="y" <!-- IF REQUIRED_6 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="tel" value="n" <!-- IF ! REQUIRED_6 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                                <tr valign="top" class="bg">
                                                        <td>{L_780}</td>
                                                        <td>
                                                                {L_yes}<input type="radio" name="tel_regshow" value="y" <!-- IF DISPLAYED_6 -->checked="checked"<!-- ENDIF -->>
                                                                {L_no}<input type="radio" name="tel_regshow" value="n" <!-- IF ! DISPLAYED_6 -->checked="checked"<!-- ENDIF -->>
                                                        </td>
                                                </tr>
                                        </table>
                                        <input type="hidden" name="action" value="update">
                                        <input type="hidden" name="csrftoken" value="{_CSRFTOKEN}">
                                        <input class="btn btn-primary" type="submit" name="act" class="centre" value="{L_530}">
                                </form>
                                </div>
                                </div>
                </div>
